Guest post by Ellen Derrico, director of global market development, life sciences and healthcare at QlikTech.
Electronic health records (EHRs) are getting a lot of attention these days, but amid the hype there are skeptics out there arguing that the EHR is old news. However, I’d like to argue that the EHR is not dead; in fact, it’s growing up.
Today’s EHRs are so much more than a digital version of a paper chart. They are evolving and getting more sophisticated. One of the most promising and exciting developments of this is the integration of data discovery and analytics to analyze and compare EHR data. Where business intelligence (BI) was once used primarily to analyze data from a business perspective – revenue cycle management, finance, supply chain management – it’s increasingly being used to analyze patient data, physician performance, facility and utilization – all to improve clinical outcomes.
In healthcare, data discovery and analytics offer the possibility of improving patient care by synchronizing the resource planning with patient logistics and allowing physicians and nurses to focus on improving performance. With BI technology medical practitioners can look across data from different people and locations to support decision making not only for their individual patients, but also for larger patient populations. As a result, practitioners can improve patient outcomes and population health.
Guest post by James Hofert, Roy Bossen, Linnea Schramm and Michael Dowell, all partners with Hinshaw & Culbertson.
New federal healthcare legislation and implementing regulations, seek to exert control over multiple aspects of patient care. The Health Information Technology for Economic and Clinical Health Act (“HITECH”)[i] with staged implementation through 2016, seeks to not only promote implementation of electronic health record systems (“EHR”), but also regulate electronic communications of health information by and between the patient, physician, hospitals and other healthcare institutions so as to enhance care quality, care coordination and reduce costs.
HITECH further envisions implementation of clinical decision support algorithms for the diagnosis and treatment of disease both during admission and after discharge. The Hospital Readmission Reduction Program[ii], effective October 1, 2012, consistent with the objectives of HITECH seeks to financially penalize hospitals for higher than standardized readmission rates for heart failure, acute MI and pneumonia. The Center of Medicine and Medicaid Service (“CMS”) intends to expand application of the program to readmission for COPD, elective total hip arthroplasty and elective total knee arthroplasty in 2015[iii]. Consistent with preventative care goals so as to mitigate further health care problems as found in HITECH, CMS has refused to adjust the re-admission penalty program to account for readmissions unrelated to the patient’s initial hospitalization even though the readmission could be considered to be outside the hospital’s or physician’s control[iv].
It is no surprise many hospitals and eligible professionals are “heads down” on meaningful use Stage 2 preparations. EHR upgrades, evaluating performance against increased thresholds for carry-over objectives from Stage 1, and delving into the technical, procedural and workflow complexities of many new objectives has caught many providers off guard, particularly those for whom meeting Stage 1 was a relatively easy goal.
Two very challenging areas for Stage 2 for most eligible hospitals (EHs) and eligible professionals (EPs) are the objective “Summary of Care Record at Transitions of Care (ToC)” and those that relate to Public Health reporting.
For these objectives, it is not necessarily the performance thresholds that present the challenge, rather the EHR functional requirements, the requirements-behind-the-requirements, or the workflows that are the cause of consternation. These objectives and their unique challenges are described below:
Summary of Care Record at Transitions of Care (ToC).
This objective is challenging on two fronts. First, the population and generation of the Summary of Care Record (the “Record”), and second, the actual transmission of that document at transitions of care to intended recipients.
CIOs in healthcare face the constant challenge of doing more with less. Most are being asked to dramatically cut costs while continually tackling an ambitious list of responsibilities, including maintaining their organizations’ ability to demonstrate meaningful use, making the transition to ICD-10, sharing information through healthcare information exchanges (HIEs) and maintaining stringent patient privacy and HIPAA compliance programs.
Three key and often overlooked elements can help to address these tasks: document scanning, clinical language understanding and integration standards. Mastery of this electronic health record (EHR) trifecta can significantly simplify the healthcare CIO’s challenge.
Electronic health record adoption levels are steadily increasing, but ongoing interoperability issues result in high volumes of paper-based communications between providers. In fact, a survey conducted by the Bipartisan Policy Center in Washington, D.C., found that 71 percent of physicians identified lack of EHR interoperability and exchange infrastructure as major barriers to HIE.
Kareo, a company I have come to quietly respect (the company does not sponsor this site in any way) issued the following graphic (something else I have come to really like). I’m a visual person and there’s often no better way to convey complicated information like that found in health IT and I find the following graphic filled with much telling information, and seems to beg whether small practices are served well by EHRs.
This graphic seems to speak to a bigger picture of what’s going on currently in the space. This information tells the story of how it is becoming more difficult to maintain autonomy in private practice, but not impossible. With technology, small practices can thrive. But, is there enough focus on the small practices for technology to make the difference Kareo says it can?
Kareo has skin in this game, after all, and makes its position clear: “The solution is technology, and not just one piece of software but a fully-integrated seamless package of solutions from a single vendor … most physician practices know that to remain independent they will have to make changes.
“The willingness to change is important because success may rely on seeing your practice as a business and carefully considering and evaluating your bottom line. While many physicians in practices with five providers or fewer are still hesitant to adopt an EHR, the potential benefits are indisputable.”
Like the adaption and implementation of every new and innovative technology, it takes time to get used to it. Therefore, with electronic health records, being ready for change is key.
Previously, physicians were comfortable with a paper-based system because its usage had been a norm since and before they started studying medicine. The way they had to learn and adopt to a working environment when they started practicing, they will have to do the same with innovative technologies such as EHRs, built to make their lives easier.
In the initial stages, EHR documentation is likely to be cumbersome as physicians familiarize themselves with the new system.
ONC’s HealthIT.gov published the following graphic aimed directly at consumers, expanding on its education strategy. For those that live in health IT, much of the information included here has been seen multiple times. Perhaps there is little new here.
However, there are a few nuggets that I personally find of interest that are worth sharing. According to the the feds, “between 2001 and 2011, the number of doctors using an EHR system grew about 57 percent, making it easier for you and all of your doctors to coordinate your care, and often reducing the chance of medical errors.”
Now that studies have suggested that about 66 percent of the population would switch to a doctor using an EHR versus one not using one, we’re going to see this stat is every piece of collateral in support of the effort; in fact, that same story has been reported here at this twice (this makes the third time). That detail is included here, too, as we would expect.
Guest post by Tyler Hayes is co-founder and CEO of Prime, the personal social network for your health.
Despite numbers the VA and ONC have shared, Blue Button is effectively not being used. Consumers haven’t heard of it. Developers aren’t implementing it. It’s not blossoming into what it can and should be.
This is happening for several reasons. I’d like to share some brief thoughts on our industry’s relationship with Blue Button, why it lacks adoption, and its currently troubled future.
First, there’s its identity crisis.
Blue Button is not the same as Blue Button+. Blue Button+ is Blue Button on steroids. That’s a good thing. But Blue Button+ is really two things, which makes it more confusing. That’s a bad thing. Blue Button+ is really Blue Button+ Push and Blue Button+ Pull. I hear the former may be renamed to Blue Button+ Direct and the latter to Blue Button+ REST API. Thoughts on the names aside, this is again more room for confusion.
This confusion, just from these few terms, is turning developers off from adopting Blue Button. When developers are confused, you can guarantee consumers are confused. We’ve seen both first hand in non-trivial amounts. That’s very bad.
From this point forward, I’m going to refer to all of these as just one whole: Blue Button. To do otherwise is to descend into madness. This is how Blue Button should exist right now anyway.
Even if Blue Button were to fix its identity crisis, it would still suffer from fragmentation of resources like documentation and community efforts.
The rapidly growing and changing technology landscape of the healthcare industry means that companies catering to this market are also rapidly developing and adapting.
Technological advancements are happening so quickly that healthcare companies have to be able to move quickly to stay relevant and effective. This can be a challenge for large, public companies because there are a lot of moving parts that all need to be working in unison to make the vehicle run, not to mention many layers of approval to navigate.
A private company can be more nimble, more customer-oriented and more experimental with the way they use technology. In an industry where “fly-by-night” companies are a regularly accepted occurrence, there is something to be said for well-established, stable and privately held companies in the healthcare industry and the benefits they can provide to their customers.
Collaboration has proven to be key when moving to a meaningful use certified electronic health record, time and time again. The same can be said about upgrading to a MU certified EHR.
From a single site opened in 1996, Santa Rosa Community Health Centers (SRCHC) has become a major provider of healthcare services in Sonoma County with more than 102 participating providers serving a patient population of 40,000 through eight facilities.
Services include family planning and reproductive health, HIV, mental health, obstetrics, outreach and education, pediatrics, primary care, senior and older care and teen services. SRCHC is a federally qualified health center, and provides more than 183,000 medical visits each year.